The National Eating Disorder Association (NEDA) recently reported that the number of men admitted into hospitals for eating disorders like anorexia and bulimia went up 70% from 2010 to 2016. And while that may sound troubling — it most definitely is — it also means that more men with eating disorders are actually seeking help.

Approximately 15% of gay and bi men will struggle with an eating disorder at some point in their lives, and 42% of men with an eating disorder identify as gay or bisexual, so it’s important to understand why and how we can put a stop to this trend.

Gay men are seven times more likely than straight men to report binge eating, and 12 times more likely to report food purging (bulimia), according to NEDA.

Tyler Wooten, Medical Director of the Eating Recovery Center in Dallas, says genetics and widespread homophobia both contribute to the high rates:

A lot of times what we say is that the genetics load the gun, but the environment pulls the trigger. There seems to be a kind of temperament that is innate and born with that makes someone susceptible to societal pressures. The temperament of these folks is sensitive, perfectionistic, pleasing, sort of driven and very interested in making other people happy. … One thing that makes LGBT people susceptible to this is that we are folks that really want to be liked and accepted.

Brian Pollack, a New Jersey therapist who specializes in eating disorders, attributes the trend to a gay cultural obsession with beauty and fitting in:

Gay men generally report lower body satisfaction than heterosexual men. The research states they are also more likely to agree that they experienced objectification and pressure from the media to be attractive. We also hear more concern regarding gay culture and the nicknames the community utilizes to stereotype themselves by the way they speak, act, feel and look. … For some, trying to fit in a community after not fitting in with family or heterosexual community stereotypes can often create pressure that is confusing.

Gay men will sometimes joke about never eating appetizers or carbs at social functions, will disparagingly refer to themselves or others as “fat asses” for enjoying dessert or will criticize others for their physical appearance. All these behaviors contribute to a toxic atmosphere that warps their relationship to food, weight and their bodies.

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2. Eating disorders can start for a variety of different reasons.

While a combination of biological, psychological and environmental factors can contribute to a person developing an eating disorder, the actual behaviors sometimes arise from an innocent desire to lose weight or desire to recover from a trauma-like abuse or rape. Controlling what goes into your body restores a feeling of control, and weight loss can help shed an old self-image.

Eating disorders, however, are often accompanied by an underlying dissatisfaction with one’s body, a negative self-image, an over-idealizing thinness, an obsessiveness over dieting or a lack of familial or peer support.

And while bulimia and anorexia remain the most common eating disorders, orthorexia — an obsession with purity, good foods, health and exercise — is a newer one that hides within “health-nut” culture.

3. People unwittingly encourage men to have an eating disorder.

Well-intentioned friends, co-workers, family members and even personal trainers can encourage a person to continue their eating disorder by offering compliments about their physical appearance and weight loss — compliments like “You look great!” and “Wow! You’re doing so well! Keep it up!”

These compliments are fueled in part by a social stigma against fatness and an ignorant belief that all plump bodies are unhealthy.

Some men find support to continue their eating disorders by joining pro-eating disorder online groups where users post images and stories seeking “thin-spiration” to continue their self-starvation.

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4. The belief that eating disorders are a “women’s issue” add shame to men.

Since most people associate eating disorders with women, they may not consider that a man’s rapid weight loss is actually an eating disorder and not just exercise, dieting or a physical illness.

Oddly, the popular conception of eating disorders as “a women’s problem” adds extra shame to men who struggle with eating disorders, compelling them to hide it lest they get seen as weak or effeminate.

5. People use various methods to hide their eating disorders.

They’ll claim to have eaten elsewhere, lie about their food intake, attribute their loss of appetite to illness, secretly spit food into napkins or the toilet, schedule work or social events over meals or even hide or throw food away to make it seem like they’re eating.

To see past the deception, look for the following clues: People with eating disorders might be more withdrawn or anxious, preferring to spend time alone (especially at meal times) rather than at social situations they used to enjoy; they might become obsessed with details about food such as what you’re eating, calorie or fat content, strictly avoiding certain foods or eating in a new or systematic way (preparing their own foods or eating in a regimented or peculiar way).

People with eating disorders might also feel much more tired, have insomnia, have difficulty concentrating, experience mood swings or get frequently ill. It’s okay to ask you friend if they’ve been eating well or taking care of themselves. You can even mention that similar symptoms are linked to eating disorders without directly suggesting that they have one.

6. Stress can make men relapse into an eating disorder.

Eating disorders are partially driven by a need to feel in control — controlling your body can help you feel powerful when the rest of the world seems outside of control. So some men who have overcome their eating disorders may feel tempted to relapse in periods of great stress. Some do.

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7. Talking about eating disorders helps people seek treatment.

Recently, a number of high-profile male celebrities — including rapper Eminem, pro-skateboarder Bam Margera, actors Dennis Quaid, Robert Pattinson and bi musician Aaron Carter — have spoken openly about their eating disorders. NEDA says that talking openly can help others seek out treatment to get the help they need.

If a friend talks to you about his eating disorder, NEDA suggests giving him reaffirming messages that don’t focus on his body — for example, compliment his personality or life achievements.

NEDA also suggests not making rules, promises or expectations that you can’t or won’t keep. Try to avoid statements like “I promise not to tell anyone” or “If you do this one more time, I’ll never talk to you again.”

If you or someone you know struggles with an eating disorder, contact the National Eating Disorders Association at (800) 931-2237.